Provider Demographics
NPI:1578736948
Name:GIBBONS, LUKE (BS,MS,RPH)
Entity Type:Individual
Prefix:DR
First Name:LUKE
Middle Name:
Last Name:GIBBONS
Suffix:
Gender:M
Credentials:BS,MS,RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 ROSSWAY RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:12569-7509
Mailing Address - Country:US
Mailing Address - Phone:845-635-6019
Mailing Address - Fax:845-471-8135
Practice Address - Street 1:59 BURNETT BLVD
Practice Address - Street 2:STOP AND SHOP PHARMACY
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-6446
Practice Address - Country:US
Practice Address - Phone:845-471-4526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY36517183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY36517OtherNYS LICENSE